Patient falls: what went wrong?

Legal nurse consultants who handled medical malpractice cases often make decisions about liability for patient falls.

A review of nursing malpractice claims dealing with many different types of claims revealed that the allegations fit into one of these six categories:

• failure to follow standards of care;
• failure to use equipment in a responsible manner;
• failure to communicate;
• failure to document;
• failure to assess and monitor; and
• failure to act as a patient advocate.

These six allegations apply to patient fall cases. The plaintiff’s expert witness may allege any of these deviations occurred. Here are some actual fall-related cases.

Failure to follow standards of care

• failure to follow the care plan intervention that two people were needed to transfer a patient
• failure to support a paraplegic patient during a shower caused a fall and fractured pelvis
• failure to respond to a patient’s call for help resulted in the patient getting up on her own and falling
• failure to appropriately train staff in transfer techniques resulted in a head injury when patient was being transferred out of bed
• failure to respond to a patient’s request for help to get off a commode

Failure to use equipment in a responsible manner

• failure to use bed alarms and sensors
• failure to ensure that batteries were working in sensors
• failure to properly maintain a Hoyer lift, resulted in a fall
• failure to use a low bed
• failure to put up a side rail before rolling a patient on her side led to a fall off the bed
• failure to lock the wheels of a bed or wheelchair
• failure to ensure that doors to the outside or stairwells were not left propped open on units with cognitively impaired patients

Failure to communicate in patient falls cases

• failure of the nurse to fill out forms instructing the aides on how to follow fall precautions for a woman with a previous history of a fractured hip
• failure to report a fall
• failure to instruct caregivers on proper transfer techniques

Failure to document

• failure to establish and record a plan to prevent falls in a patient with 57 falls and 18 head injuries
• failure to report and record details of a fall
• failure to record telephone orders for fall prevention measures

Failure to assess and monitor

• failure to monitor a patient who fell repeatedly ultimately resulted in loss of an eye during a fall in a parking lot
• failure to assess and monitor a patient following a head injury led to undetected increases in intracranial pressure and death

Failure to act as a patient advocate

• failure to report signs of lethargy consistent with over-sedation was followed by a fall
• failure to question excessive doses of psychotropic medications